Vaccine Rhetoric vs. Reality: Pediatrician Q & A
Recent admonishments from Britain’s General Medical Board and the Lancet aside, there is still a vocal sect that believes autism is caused by the MMR vaccine. It’s not only Jenny McCarthy – if you tune in to any parenting website and the topic of vaccines comes up, you can bet the comments will go off the rails at some point during a heated discussion.
The vaccine backlash has real world consequences as we have seen a scary rash of measles and mumps outbreaks around the U.S. and other Western civilizations that have the luxury of being suspicious about inoculations against infectious disease. Wondering how parents are reacting to the recent discrediting of Dr. Wakefield, I talked to a Park Slope, Brooklyn parent and pediatrician, Dr. Philippa Gordon of Gordon & Glaser Pediatrics about how this hot button issue plays out in her office.
As a physician in Brooklyn, home to some of the most vocal parents in the country, your practice must be affected by the debate. I see a lot of heated discussions on parenting message boards, but in reality, how many parents in your practice don’t have their children vaccinated?
I would say probably two percent (2%). The effect of this debate has been not so much that people aren’t vaccinating, but that people want to talk about it a lot more. A large number of parents have devised their own schedules for when they want to vaccinate their own kids.
And you’re open to that in your practice?
I don’t encourage it, but I have to have a parent’s consent to vaccinate their kids. We have some problems with people devising their own schedule for vaccinations because if they come in just to be vaccinated, their insurance company usually won’t pay for that. Reimbursement is a problem because we have to see these kids and we don’t get reimbursed.
I worry a lot when people go on an atypical schedule that we’ll miss something. It just becomes very difficult for us to keep track. You have to be in here with your kid if you don’t want me to follow the recommended routine. You have to be here telling me what you are doing and what you are not doing.
Why is the Brooklyn clientele more vocal on this issue than other groups of parents?
It’s clearly true that in Park Slope and these areas of Brooklyn parents feel that part of their responsibility as a parent is to decide what to do about vaccinations and they really feel they have to make this decision themselves. The doctor knows what’s good in general, but they know what’s best for their kid and their family. It’s a very strong undertone for some people.
Have you seen this trend change over time?
It’s changed. Actually, I think it’s waning a little bit now.
Did the recent disciplinary action and retraction of Wakefield’s study by the Lancet, change any minds?
I think in the past couple of years there have been changes. What’s interesting is another time when I saw a big change in people worrying about vaccines was right after the World Trade Center events. People calmed down about vaccines a lot. Then it rose up again. I feel like it’s all kind of played out. Everybody is getting over it a little bit.
Did you have any patients who contracted measles during last summer’s outbreak?
No, I didn’t. But one of our patients is radio journalist and she did a story about the outbreak in California. A lot of people came in and talked to me about that story. It seems – in this community, anyway – a lot of people listen to NPR and that story had a strong effect on what people thought. What I’m hearing more of now that I didn’t hear two or three years ago is personal responsibility. That didn’t come into the discussion very much a few years ago and now it’s coming up a lot more that people feel they have a responsibility to vaccinate their kids and that they want other people to vaccinate their kids.
How do you talk to a parent who comes into your office and won’t vaccinate because of the fear of autism?
It’s hard because there’s a lot of misinformation that people are exposed to and it’s scary. We have very, very clear evidence that there is no correlation between any pattern of vaccinating at all and autism. One of the anecdotes that I think people find quite compelling is there was a time in Japan when they couldn’t get any MMR vaccines and for a number of years there was no MMR vaccine available in Japan. During that time the rate of autism continued to rise the same as everywhere else. And of course people like things that happen on an island – like a little natural experiment. So when you show people the statistics and they see there is no correlation not only between MMR and autism but also between any vaccination pattern and autism that seems to be helpful.
Is it just autism? Or has the fear of vaccines grown into something else?
The fear of vaccines has a symbolic value to parents; fear of the environment, fear of the unknown, fear of big medicine, big pharmacology and big business. People are afraid of big forces acting on their child’s life and taking away control of their child. But very few parents really, really believe you would do something to their child that is harmful. It really is just one to two percent that just can’t bring themselves to vaccinate their child. To me, in families like that the whole vaccination thing has some other meaning. It’s not just about the vaccines. Whatever their parental anxieties are, it’s taking a symbolic form.
Has this fear become prevalent just in the last 15 or so years, or longer?
It actually started before Wakefield and it stared with the pertussis vaccine. What’s interesting to know is when vaccines do have side effects it’s a side effect that is also a side effect of the native disease. So the pertussis vaccine caused high fever and the pertussis germ causes high fever. Then the question was raised about the Guillain-Barre Syndrome and the Swine Flu vaccine because there was an excess of Guillain-Barre Syndrome after the first vaccine under the Carter administration. But the native flu causes more Guillain-Barre. People feel like it’s out of the blue, but it’s not some totally mysterious thing that happens: in every single case when a vaccine is found to have a serious side effect it’s always a side effect of the native disease. Which is sort of comforting.